You’ve likely seen and heard numerous catchy commercials touting the benefits of drugs to treat diabetes. And you may be getting questions from patients, or even from friends and family about the use of these medications for weight loss. As a nurse, it’s important you are well-informed and up to date so you can share the latest evidence and recommendations.
The World Obesity Federation (2023) projects over 50% of the global population (over 4 billion people) will be overweight or living with obesity by 2035 if current trends continue. Typical treatments for obesity focus primarily on diet and exercise, however, for many these lifestyle modifications aren’t enough. Obesity is a complex metabolic disease involving internal mechanisms that make weight loss difficult. Clinical guidelines now recommend the use of medications for individuals with obesity or who are overweight with weight-related complications (Jastreboff et al., 2022). These medications involve “long-acting glucagon-like peptide-1 (GLP-1) receptor agonists that target endogenous nutrient-stimulated hormones as well as glucose-dependent insulinotropic polypeptide (GIP), a nutrient-stimulated hormone that regulates energy balance through cell-surface receptor signaling in the brain and adipose tissue” (Jastreboff et al., 2022). Let’s explore a few of these medications.
Semaglutide is a GLP-1 receptor agonist that is approved by the U.S. Food and Drug Administration (FDA) to treat type 2 diabetes mellitus (T2DM) in adults (brand name Ozempic) or to assist with weight loss management in individuals with obesity (brand name Wegovy).
Semaglutide works by (Facts & Comparison, 2023):
- Increasing insulin secretion
- Decreasing inappropriate glucagon secretion (a hormone that increases blood glucose)
- Slowing gastric emptying, promoting a feeling of fullness
- Acting on the areas of the brain that regulate appetite and caloric intake
Semaglutide is not without disadvantages. It is associated with several major adverse effects such as diabetic retinopathy complications, acute kidney injury, gallbladder and biliary tract disease, gastrointestinal symptoms (abdominal pain, constipation, diarrhea, nausea, and vomiting), allergic reactions, medullary thyroid carcinoma, and pancreatitis (Lexicomp, n.d.).
Two semaglutide drugs in high demand today are Ozempic and Wegovy.
First approved by the FDA in 2017, Ozempic is an injectable prescription medication used in combination with diet and exercise to improve blood sugar in adults with T2DM. It is also used to decrease the risk of major cardiovascular events such as heart attack, stroke, or death in adults with T2DM with known heart disease. It is administered as a subcutaneous injection into the abdomen, thigh, or upper arm and should not be taken intramuscularly (IM) or intravenously (IV). It is formulated with different doses of semaglutide (0.5 mg, 1 mg, or 2 mg) with an initial dose of 0.25 mg subcutaneously weekly for the first 4 weeks, titrated up to 2 mg if needed to achieve glycemic control. Ozempic should be taken once a week, on the same day each week, at any time of day. It should not be mixed with insulin or given in the same injection. It is important to emphasize that Ozempic is only FDA approved to treat T2DM, not Type 1 DM, and is not approved to treat obesity.
Wegovy is a prescription medication approved in 2021 as an adjunct to diet and exercise to help with obesity in individuals with a body mass index (BMI) greater than or equal to 30 kg/m2
(or in individuals with a BMI greater than or equal to 27 kg/m2
with one or more comorbidities such as hypertension or dyslipidemia). It contains a higher dose of semaglutide (2.4 mg) compared to Ozempic. Wegovy is also administered subcutaneously, with an initial dose of 0.25 mg once weekly titrated slowly up to 2.4 mg/week. Individuals with a personal or family history of medullary thyroid cancer or multiple neoplasia syndrome type 2 should not use Wegovy.
A Note on Supply Shortages of Semaglutide
While Wegovy is FDA approved to treat obesity, it isn’t typically covered by insurance and can be very expensive. Despite the high cost, Wegovy is in high demand, which has resulted in supply shortages. Many people without T2DM are attempting to use Ozempic off-label for weight loss making it difficult to obtain for those who need the medication to manage their T2DM. It's necessary to note that while these drugs help individuals to lose weight, if they discontinue its use, they are likely to regain the weight back within months. These medications should be taken long-term and not as a short-term fix for weight loss.
Tirzepatide (brand name Mounjaro) is a once-weekly subcutaneous injectable peptide approved by the FDA in 2022 for T2DM with agonist activity at both the GIP and GLP-1 receptors. In clinical trials, individuals who took tirzepatide lost 19.5% and 20.9% of body weight with 10 mg and 15 mg doses respectively compared to placebo. The initial dose of tirzepatide is 2.5 mg subcutaneous once weekly for 4 weeks, then increased to 5 mg once weekly. The dose may be titrated by 2.5 mg per week increments every 4 weeks to achieve glycemic goals with a maximum weekly dose of 15 mg/week subcutaneous.
Monitoring Patients Taking Semaglutide or Tirzepatide
For individuals taking semaglutide or tirzepatide, be sure to monitor the following parameters closely (Facts and Comparisons, 2023):
- Plasma glucose
- GI adverse reactions (i.e., nausea, vomiting, diarrhea)
- Kidney function (at baseline and following dose increases)
- Pancreatitis (i.e., abdominal pain with or without vomiting)
- Gallbladder disease
- Worsening diabetic retinopathy
- Hemoglobin A1C (HbA1C) for individuals with T2DM:
- Monitor at least twice yearly in patients with stable glucose.
- Monitor quarterly in patients who have not met treatment goals.
- Monitor in combination with blood glucose levels in patients prone to glycemic variability or in patients whose HbA1C is inconsistent with serum glucose levels.
As these medications continue to gain popularity, ensure you are knowledgeable of the administration, adverse effects and monitoring parameters associated with them. For complete information, please consult each drug’s package insert or the Nursing2023 Drug Handbook® + Drug Updates.